Endobronchial teratoma associated with bronchiectasis and bronchiolectasis

Endobronchial teratoma: A systematic review of the literature with a case report

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Endobronchial teratoma is an extremely rare disease.

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Presentation could mimic bronchogenic cancer.

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Lobectomy or pneumonectomy is the treatment of choice.

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A brief review with a new case has been discussed.

Introduction

Endobronchial teratoma is sporadic disease. The study aims to present a case with endobronchial teratoma with a brief literature review. A 26-year-old male presented with a history of frequent attacks of chest infection for the last two years. Chest examination showed diffuse wheeze all over the left side of the chest. Chest x.ray showed opacification involving all of the left side of the chest with elevated left hemi diaphragm while computed tomography scan confirmed complete collapse of the left lung with consolidations and air bronchogram. Flexible bronchoscopy showed near-total obstruction of the left main bronchus. Under general anesthesia, left pneumonectomy was performed. The result of the histopathological examinataion showed mature teratoma.

Conclusion

Endobronchial teratoma is an exceedingly rare type of intrathoracic teratoma that mainly affects males and is usually diagnosed at the 3rd decade of life; lobectomy or pneumonectomy are optimal managements for these cases.

Mediastinal teratoma presenting with hemoptysis and pleuritis misdiagnosed as tuberculosis (empyema)

Background

Mediastinal teratoma is uncommon in children. It can be very difficult to diagnose especially in early stage. Rarely, teratoma may rupture into adjacent structures and lead to lung lesions or pleuritis. The main rarity of our reported cases was the dynamic imaging findings very similar to the developmental process of tuberculosis in patients 1 and 2, the pachypleuritis in patients 2 and 3, the extremely elevated inflammatory markers very similar to empyema in patient 3, and the extremely atypical tumor shape in all patients.

Case presentation

We present three pediatric patients presenting predominantly with recurrent hemoptysis and/or chest pain who were ultimately diagnosed with mediastinal teratoma containing pancreatic tissue. All three patients were initially suspected to have tuberculosis or empyema, and underwent relevant treatment, but without improvement. Patient 1 had left hilar enlargement, and subsequently an enlarging calcified cavity within high-density consolidation was identified. Patient 2 initially presented with right-sided pulmonary consolidation and pleuritis, and subsequently developed right lower lobe calcification, pleural thickening, and irregular soft tissue in the right inferior mediastinum. Patient 3 was initially found to have right lobe consolidation accompanied by a massive right-sided pleural effusion with extremely elevated inflammatory markers in serum and pleural effusion. The effusion later acquired heterogeneous density and appeared to become encapsulated. In patients 2 and 3, pleural biopsy identified fibrous tissue (with and without granuloma). Thoracotomy/thoracoscopy revealed mediastinal teratoma in each case, all of which were completely excised and the patients made uneventful recoveries. Histopathologic analysis revealed mature cystic-solid teratoma containing pancreatic tissue in all patients, and calcification in patients 1 and 2.

Conclusions

Clinicians should be mindful that mediastinal teratoma is a potential cause of hemoptysis, lung lesions and pleuritis. Calcification and pachypleuritis on chest imaging especially in patients without fever should be highly suspected of mediastinal teratoma. Pleural biopsy sometimes fails to assist in making a definitive diagnosis.

Ectopic Anterior Mediastinal Pathology in the Chest: Radiologic-pathologic Correlation of Unexpected Encounters with the "Terrible Ts"

The complex embryology of the anterior mediastinum makes it home to an array of primary neoplasms tied to the presence of the thyroid and thymus glands in that compartment. While the occurrence of ectopic thyroid deposits in the extramediastinal thorax has not been convincingly established, the other three “Ts” of the classic “4T” mnemonic for the differential diagnosis of an anterior mediastinal mass have occurred in the lung parenchyma, pleural space, and endobronchially as primary tumors. Finding any of the three lesions – thymoma, teratoma, or B-cell lymphoma – in the chest outside the mediastinum is very unusual, but that possibility exists. Herein, we illustrate examples of this rare phenomenon.

Gastrointestinal stromal tumours (GISTs): a clinicopathological and molecular study of 66 cases

AIMS

Predicting the clinical behaviour of gastrointestinal stromal tumours (GISTs) is difficult and criteria delineating benign from malignant cases are not firmly established. The aims of this study were to define the clinicopathological and molecular features of 66 GISTs, and to determine whether any specific parameters were associated with patient outcome.

METHODS

Archival cases of GIST from two major teaching hospitals in Western Australia were studied. Inclusion criteria for the study were: (1) appropriate morphology, (2) CD117 positivity, (3) adequacy of pathological material for study, and (4) exclusion of other tumour types on the basis of immunophenotypic and/or ultrastructural features. Expression of CD117, CD34, S100 protein, keratin (using broad spectrum MNF116), alpha-smooth muscle actin (SMA) was determined by immunohistochemistry. PCR and single strand conformation polymorphism (PCR-SSCP) analysis were used to screen for mutations in exons 11 and 9 of c-kit.

RESULTS

There were equal numbers of males and females with a mean age at diagnosis of 60 years, followed up for a mean of 54 months. Thirteen patients (21%) had died of GIST by the end of the study. Tumours were mostly located in the stomach (67%) and small intestine (SI; 25%). The cell types were pure spindle (68%), pure epithelioid (12%) and mixed epithelioid/spindle (20%). c-kit mutations were found in 69% of GISTs, with the large majority (91%) occurring in exon 11. Size > or = 10 cm, tumour necrosis and pure epithelioid cell morphology each were the only factors significantly associated with adverse survival (p=0.038, and p=0.047 and p=0.028, respectively). Mitotic activity > or = 5/50 HPF showed a definite trend association with adverse survival, but unlike some other studies, did not achieve statistical significance (p=0.067). c-kit mutations were more frequent in small intestinal GISTs (p=0.05) and in those with pure spindle cell morphology (p=0.023) but were not associated with patient outcome.

CONCLUSION

In this study, size > or = 10cm, necrosis and/or pure epithelioid cell morphology correlated significantly with adverse survival. Mitotic activity showed a strong association with survival but this did not reach statistical significance. c-kit mutations occurred mainly in GISTs of the SI, and in purely spindle cell tumours. While the mutation status did not associate with patient outcome in this series, this remains a controversial issue, and further studies are needed to assess whether the type of mutation affects response to tyrosine kinase inhibitor therapy in metastatic GISTs. CD117 staining of any mesenchymal lesion of the gastrointestinal tract should be mandatory for accurate classification. PCR-SSCP analysis is a fast, sensitive and relatively inexpensive method of analysing c-kit mutations, which may be important prognostically and also of therapeutic relevance in the assessment of new tyrosine kinase inhibitor therapies.

Benign cystic teratoma of the lung

A young man with recurrent cough and hemoptysis was found at thoracotomy to have benign intrapulmonary cystic teratoma. Although benign cystic teratomas are a common mediastinal neoplasm, they rarely occur within the lung parenchyma. Fewer than 30 cases have been reported in the literature. Occasionally, patients present with bronchiectasis, abscess, or pneumonia in addition to cough and hemoptysis. The patient in this report had little evidence of infection and recovered rapidly following surgical excision of the mass.

Intrapulmonary teratoma 10 years after removal of a mediastinal teratoma in a young man

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Tracheobronchial tumors: an eighteen-year series from Capital Hospital, Peking, China

From 1961 to 1979 in Capital Hospital, Peking, China, 27 patients with tracheobronchial tumors were treated: 20 underwent operation and 7 were managed by palliative measures. All 27 patients had an intraluminal lesion of the trachea or major bronchi. Respiratory obstruction was the main clinical manifestation of the tracheal tumors. Chronic suppurative infection of the lung was the principal clinical manifestation of the bronchial tumors. Histological diagnosis of these 27 patients revealed ten different cell types: squamous cell carcinoma (10 patients, including the 7 who did not undergo operation); adenoid cystic carcinoma (5 patients); carcinoid, hamartoma, neurofibroma, and papilloma (2 patients each, respectively); and leiomyoma, hemangioma, chondroma, and teratoma (1 each, respectively). The operative methods used in 20 patients were lateral resection of tracheal wall (2 patients), resection of left main bronchial root (1), local excision (5), lobectomy (5), pneumonectomy (3), bronchoscopy (1), and exploratory operation and tracheostomy (3). Local excision or lateral wall resection of the trachea was chosen for benign or less dangerously malignant tracheal tumors. Lobectomy or pneumonectomy was performed for the secondarily infected, destroyed lungs in patients with bronchial tumors.

Endobronchial teratoma

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Undifferentiated carcinoma in young men: the atypical teratoma syndrome

In 5 young men with apparent undifferentiated carcinoma involving lung, mediastinum, and lymph-nodes subsequent response to treatment, tumour-marker analysis, and histology review suggested a diagnosis of embryonal-cell carcinoma. It is suggested that atypical presentation of extragonadal germ-cell tumours may be common. Because such tumours respond to chemotherapy, accurate diagnosis is essential.

A teratoma of the lung containing thymic tissue

A case of a benign, cystic intrapulmonary teratoma occurring in the left lobe of a 63-yr-old female is described and the typical clinical symptoms and distinguishing X-ray appearances which may be helpful in diagnosing this rare tumour are mentioned. The connection between the tumor and the segmental bronchus clearly established the true intrapulmonary nature of the lesion in this case and the unusual finding of thymic tissue within the wall supports previous speculation regarding the possible thymic origin of these neoplasms.

Mediastinal extragonadal germ cell tumors

Mediastinal germ cell tumors are a rare primary malignancy. An overview of the presenting clinical symptoms, radiographic appearance, patterns of extention and metastasis, and autopsy findings are presented. The difficulty in totally excluding an occult gonadal primary lesion in noted. The theories of the genesis of these tumors are briefly reviewed.

An intrapulmonary teratoma associated with thymic tissue

A benign teratoma was removed by segmental resection from the upper lobe of the right lung in a girl aged 19 years. This is the twentieth case report of a teratoma occurring in the lung substance and is of special interest because of the identification of thymic tissue histologically. The significance of this in relation to the pathogenesis of intrathoracic teratoma is discussed.